Mini Z burnout survey - American Medical Association



Mini Z burnout surveyAnswer the following questions as truthfully as possible to determine your workplace stress levels and how they measure up against others in your field. There are two sections of questions in this survey about your experience with burnout and your practice environment. When you have completed the survey, return it to the person who requested that you complete it or submit it to stepsforward@ama-. We will follow up with you to give you your results. Thank you. Mini Z burnout surveyName:Role:Team/department:Date of survey:For questions 1-10, please choose the answer that best describes your experience with burnout. Please circle your answers.Overall, I am satisfied with my current job:1 Strongly disagree2 Disagree3 Neutral4 Agree5 Strongly AgreeI feel a great deal of stress because of my job:1 Strongly disagree2 Disagree3 Neutral4 Agree5 Strongly AgreeUsing your own definition of “burnout,” please circle one of the answers below: I enjoy my work. I have no symptoms of burnout. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot. I feel completely burned out. I am at the point where I may need to seek help.My control over my workload is:1Poor2Marginal3Satisfactory4Good5OptimalSufficiency of time for documentation is: 1Poor2Marginal3Satisfactory4Good5OptimalWhich number best describes the atmosphere in your primary work area? 1Calm23Busy, but reasonable45Hectic, chaotic My professional values are well aligned with those of my department leaders:1 Strongly disagree2 Disagree3 Neither agree nor disagree4 Agree5 Strongly AgreeThe degree to which my care team works efficiently together is:1Poor2Marginal3Satisfactory4Good5OptimalThe amount of time I spend on the electronic health record (EHR) at home is: 1Excessive2Moderately high3Satisfactory4Modest5Minimal/noneMy proficiency with EHR use is:1Poor2Marginal3Satisfactory4Good5OptimalTell us more about your stresses and what we can do to minimize them (optional): Your clinical practiceAnswer the following questions as truthfully as possible to determine your workplace stress levels and how they measure up against others in your field.For the following, please tell us about yourself and your practice. Please fill in the blanks.Are you: __ MD/DO __ NP __ PA __ Other (specify):____________________Specialty:Practice name:City of practice:State of practice:Practice size (# physician FTEs):Are you: __ Employed __ OwnerPractice type: __ VA __ Non-VAPractice specialty:EHR vendor (optional):For the following, please choose the answer that best describes you. Where do you spend the majority of your clinical time? __ Inpatient __ OutpatientPlease tell us the number of years in your current role: ____________Gender (optional): __ Female __ Male Race (optional): __ Black or African American __ Asian __ Native American __ Native Hawaiian or Other Pacific Islander __ White Ethnicity (optional): __ Latino/Hispanic __ Not Latino/Hispanic __ Prefer not to answer*Questions drawn mainly from the Physician Worklife Study, MEMO study, and Healthy Workplace Study. The Mini Z was developed by Dr. Mark Linzer and team at Hennepin County Medical Center, Minneapolis. For more information please contact mark.linzer@.Thank you for taking the Mini Z survey. ................
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